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This clearance is issued on condition that all Fire Code provisions now adopted or shall thereafter be adopted shall continue to be complied with until completion of construction. Violation of Fire Code provisions shall ipso facto cause this clearance null and void and shall hold the owner of the building liable to the penalties provided for by the said Fire Code RA 9514. FIRE STATION LETTER HEAD Number Pre-Numbered FIRE SAFETY EVALUATION CLEARANCE Date TO WHOM IT MAY CONCERN By virtue of the provisions of RA 9514otherwise known as the Fire Code of the Philippines of 2008 the application for FIRE SAFETY EVALUATION CLEARANCE for the Name of Building/Structure/Facility to be constructed/renovated/altered/modified/change of occupancy located at Address Name of Owner/Representative is hereby granted FIRE SAFETY EVALUATION CLEARANCE after said building plans and other documents have been duly evaluated with the recommendations in the Fire Safety Checklist FSC be adopted in compliance with the requirements of the Fire Code of the Philippines of 2008 RA 9514 and its Implementing Rules and Regulations. Fire Code Fees OPS No O. R* Number Date RECOMMEND APPROVAL CHIEF FSES APPROVED CITY/MUNICIPAL FIRE MARSHAL NOTE This Clearance is accompanied by Fire Safety Checklist and does not take the place of any license required by law and is not transferable. Any change or alteration in the design and specification during construction shall require a new clearance. FIRE SAFETY IS OUR MAIN CONCERN Original Applicant/Owner s copy Duplicate BO/BPLO copy Triplicate BFP copy. Fire Code Fees OPS No O. R* Number Date RECOMMEND APPROVAL CHIEF FSES APPROVED CITY/MUNICIPAL FIRE MARSHAL NOTE This Clearance is accompanied by Fire Safety Checklist and does not take the place of any license required by law and is not transferable. Any change or alteration in the design and specification during construction shall require a new clearance. Any change or alteration in the design and specification during construction shall require a new clearance. FIRE SAFETY IS OUR MAIN CONCERN Original Applicant/Owner s copy Duplicate BO/BPLO copy Triplicate BFP copy. Fire Code Fees OPS No O. R* Number Date RECOMMEND APPROVAL CHIEF FSES APPROVED CITY/MUNICIPAL FIRE MARSHAL NOTE This Clearance is accompanied by Fire Safety Checklist and does not take the place of any license required by law and is not transferable. Any change or alteration in the design and specification during construction shall require a new clearance. FIRE SAFETY IS OUR MAIN CONCERN Original Applicant/Owner s copy Duplicate BO/BPLO copy Triplicate BFP copy.

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